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The art of dentistry Dr Yvonne King believes there should be more respect in the profession for aesthetic dentistry—and has blazed a trail for others to follow No-handed dentistry Are you doing yourself out of business by adopting a CAMBRA approach? Page 14 11 practice management myths exposed! Busting the assumptions of practice management Best practice guidelines Who follows them? DHSV wants to find out, page 10 The price of caring How big a problem is compassion fatigue, and how do you manage it in your practice? Page 18

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CONTENTS

COVER STORY

YOUR BUSINESS

YOUR TOOLS

Contents

October 2013

COVER STORY

NEWS & EVENTS

4. Oral health the loser NSW government follows in Queensland’s footsteps, and lets local councils decide on fluoridation; the Rethink Sugary Drink campaign is launched; the new Ministers are welcomed; tiny diamonds are the future of implants; and more…

Life imitating art

It has been a long climb, but Dr Yvonne King has become a pioneer for the recognition of the important role of aesthetic dentistry in the medical marketplace

YOUR WORLD 10. Blurred lines How closely do you follow best practice guidelines? Dental Health Services Victoria is keen to find out 14. No-handed dentistry Is adopting a CAMBRA approach to treatment doing yourself out of business? 18. The price of care Working in the healthcare sector can be draining, particularly when it feels like you’re getting nowhere fast with patients looking for an instant fix. But the natural consequence, compassion fatigue, can lead to burnout if it’s not properly managed 26. Management myths exposed Like every industry, dentistry has its fair share of management myths. We spoke with successful dental management specialists to save you the pain of discovering these myths the difficult way. Here’s what they had to say

YOUR TOOLS 29. Product guide Bite magazine’s guide to the best implants and related products for dentists on the market today

YOUR LIFE

22 03

10

14

26

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47. Tools of the trade A pharyngometer, phosphor plates, and a really sharp knife. It’s shaping up to be an interesting month...

YOUR LIFE 50. On the run Dr Tony Weir of Tony Weir Orthodontics, Greenslopes, QLD, went on a six-day run through the Simpson Desert—by choice!

Editorial Director Rob Johnson

Sub-editor Kerryn Ramsey

Creative Director Tim Donnellan

Contributors John Burfitt, Sue Nelson, Chris Sheedy, Andy Kollmorgen

9,231 - CAB Audited as at March 2013

custom content

Commercial Director Mark Brown

Sales Director Adam Cosgrove

For all editorial or advertising enquiries: Phone (02) 9660 6995 Fax (02) 9518 5600 info@bitemagazine.com.au

Bite magazine is published 11 times a year by Engage Media, Suite 4.17, 55 Miller Street, Pyrmont NSW 2009. ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media. Printed by Bright Print Group


NEWS &EVENTS

COVER STORY

YOUR BUSINESS

YOUR TOOLS

YOUR LIFE

In Queensland’s footsteps Following the lead from the Queensland government, the New South Wales government has decided local councils should decide on fluoridation

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Drinking problems The Rethink Sugary Drink campaign was launched in Melbourne this month with a new TV advertisement featuring a man consuming a large glass of fat followed by an alarming fact, “Drinking 1 can of soft drink a day can make you 5kg fatter a year”. The purpose of the Rethink Sugary Drink campaign is to raise awareness of the increasingly high amount of sugar in soft, sports, fruit and energy drinks, and to entice Australians to reduce their consumption. The excessive consumption of sugary drinks has caused leading health organisations to

Fluoride Australia’ which read, “Expect to be threatened! The community is angry, it wouldn’t surprise me if these criminals pretending to be authorties (sic) on health start going missing, eventually members of the public will snap and take matters into their own hands, its only a matter of time. People go missing over far more trivial issues.” The newspaper also reported Dr Chant was also threatened with sarin gas by anti-fluoride activists after she spoke at a heated Lismore Council meeting. The health minister has referred the material to the NSW police and had asked the Health Care Complaints Commission to investigate as well. “I have written to the Health Care Complaints Commissioner asking the commission to investigate ‘No Fluoride Australia’ as I am concerned they are providing misinformation to the public on the effect of fluoride in water supplies,” Mrs Skinner told the newspaper. Dr Chant told The Sunday Telegraph she is unswayed by the threats. 

come together at the forum to discuss the growing health risks and consider what policy’s may be put in place to help the health of the nation. Australians consume more than 1.4 billion litres of sugary drinks a year. The Australian Dental Association (ADA) says “We encourage the Australian public to be aware that the over consumption of fizzy, sports and energy drinks can have a detrimental effect to your oral health as they contain acid and sugar that will attack your tooth enamel resulting in tooth decay.” For more information or to watch the ad head to www.rethinksugarydrink.org.au, or visit www.dentalhealthweek.com.au for resource downloads. 

Photography: credit

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ealth Minister Jillian Skinner last month announced the NSW Government will commit $7.5 million to ensure councils are supported to build the vital infrastructure needed to fluoridate their water supplies. Mrs Skinner, who at the same time released a paper on the benefits of water fluoridation, said the NSW Government will undertake a suite of measures aimed at increasing rates of water fluoridation across the state. “The NSW Government is committing $5 million to ensure the 15 councils who have chosen not to fluoridate are able to provide this vital service to their communities,” Mrs Skinner said. “A further $2.5 million will be invested for the implementation of technological advancements for smaller communities with current approval for fluoridation. The evidence about fluoridation is clear—its role in ensuring good oral health and the wider health of the community is absolutely essential. Communities across NSW benefit greatly from fluoridated water and councils play an important role in delivering this service. “The NSW Liberals & Nationals came to the election with a commitment to support local councils to make local decisions. It is for this reason we are boosting our infrastructure support for councils who have avoided fluoridation, to encourage them to deliver this vital service to the community.” Mrs Skinner said recent sustained efforts by NSW Health and local clinicians have encouraged increased fluoridation rates, with two North Coast councils voting to support water fluoridation. “NSW Health—led by the Chief Health Officer Dr Kerry Chant—in partnership with local clinicians has been very successful in convincing the community of the benefits of fluoridation,” Mrs Skinner said. But a newspaper has reported that police are investigating death threats made against Dr Chant following her appearance at the Lismore council meeting in September. The Sunday Telegraph reported that messages appeared on the Facebook page of anti-fluoridation fringe-group ‘No


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NEWS & EVENTS

COVER STORY

YOUR BUSINESS

YOUR TOOLS

YOUR LIFE

A better smile isn’t the same as happiness

ADA takes scope of practice battle to the web

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The Australian Dental Association has rallied its members to sign a petition, and to write to the Dental Board of Australia and State Health Minister, opposing the DBA proposal to alter the Scope of Practice Standard for dental practitioners to allow auxiliary dental practitioners to work without supervision and to undertake additional procedures. The petition is on a dedicated website entitled Hope for Scope. The ADA says on the site that “the Dental Board’s recommendations for changes to the Scope of Practice Registration Standard undermine the role of the dentist and potentially jeopardise the quality of the dental care that Australians will be receiving in the future.” Not everyone agrees with the ADA’s concerns. Dental Hygienists Association of Australia (DHAA) president Hellen Checker says, “Endorsing dental hygiene services in this way will remove one of the most significant barriers to direct public access to preventive oral health services, which would in turn help to reverse the decline in public oral health. “The scope of practice standard to facilitate delivery of primary health care is the first step in the paradigm shift necessary for economically responsible dental service delivery and workforce training and utilization. “Many countries around the world recognise the value of preventive dental care. The recent recommendations from the Australian parliament are in keeping with international, evidence- based trends.” 

Tiny diamonds the future of implants UCLA researchers have discovered that diamonds on a much, much smaller scale than those used in jewelry could be used to promote bone growth and the durability of dental implants. Nanodiamonds, which are created as byproducts of conventional mining and refining operations, are approximately four to five nanometers in diameter and are shaped like tiny soccer balls. Scientists from the UCLA School of Dentistry, the UCLA Department of Bioengineering and Northwestern University, along with collaborators at the NanoCarbon Research Institute in Japan, may have found a way to use them to improve bone growth and combat osteonecrosis. The study, led by Dr Dean Ho, professor of oral biology and medicine and co-director of the Jane and Jerry Weintraub Center for Reconstructive Biotechnology at the UCLA School of Dentistry, appears online in the peer-reviewed Journal of Dental Research. The study found that nanodiamonds bind rapidly to both bone morphogenetic protein and fibroblast growth factor, demonstrating that the proteins can be simultaneously delivered using one vehicle. The unique surface of the diamonds allows the proteins to be delivered more slowly, which may allow the affected area to be treated for a longer period of time. Furthermore, the nanodiamonds can be administered non-invasively, such as by an injection or an oral rinse. 

Dentists need the support of health psychologists to enhance patients’ satisfaction with their appearance before they embark on aesthetic dental procedures.

These are the findings of a study by Sharmila Sarin, supervised by Dr. Koula Asimakopoulou, and colleagues from King’s College London that was presented at the British Psychological Society’s Division of Health Psychology annual conference on Wednesday 11 September in Brighton. In the study 60 participants completed the Slade Body Satisfaction Scale and a Visual Analogue Scale assessing satisfaction with their appearance before and after their dental work. They also completed a short version of the Big Five personality test before their operation.

 Irrespective of the dental procedure performed, people who were happiest about their appearance before receiving aesthetic dental treatment were those that were the happiest after treatment; dissatisfaction with one’s appearance seen in those high on neuroticism persisted after aesthetic dental work.

 Sharmila Sarin and Dr Koula Asimakopoulou said: “We wanted to establish whether personality and the views that people have about their appearance before receiving aesthetic dental treatment would influence satisfaction with the outcomes of aesthetic dental procedures.”

 “We found that it is in the patients’ and dentists’ interest to ensure that patients receiving aesthetic dental work start from as high a point of satisfaction with current appearance as possible. This will enhance the chances that they will be satisfied with the results of aesthetic dental treatment. Neuroticism is also likely to interfere with satisfaction with aesthetic dental work.” 


Welcoming the new kids Both the Australian Dental Association Inc. (ADA) and the Australian Dental Industry Association (ADIA) have welcomed the Governor General Quentin Bryce’s swearing in of the Hon. Tony Abbott as Australia’s 28th Prime Minister and his Cabinet Ministry, including new Health Minister Peter Dutton and Assistant Minister Senator the Hon. Fiona Nash. Dr Karin Alexander, Federal President of the ADA, said: “Prime Minister Abbott, whose father is a dentist, was Health Minister in the Howard Government for over four years. Health Minister Dutton has represented the shadow health portfolio for over five years. Both are intimately acquainted with health and dental issues. The ADA is keen to engage with all the Ministers and Assistant Ministers with responsibilities across the health sector. “We have enjoyed good dialogue with Mr Dutton when he was Shadow Minister and we hope to build on that relationship to continue to focus on dental health

By the numbers

and to help deliver better dental health services for all Australians.” “ADIA has a good working relationship with the new Minister and his office tat was established some time ago. The new Minister has an excellent understanding of the challenges therapeutic product suppliers face and we look forward t working with him in the pursuit of policy reforms that will benefit suppliers of quality dental products,” added Troy Williams, ADIA chief executive office. 

The Dental Board of Australia has released its most recent practitioner registrant data, giving a snapshot of the dental profession across the country as of June this year. As usual, the eastern states dominated the profession in percentage terms, with New South Wales, Victoria and Queensland accounting for 74 per cent of registered practitioners. Of those three states, the majority are in New South Wales (31.16 per cent of the total, and the lowest number of practitioners is in the Northern Territory (with 0.69 per cent). A demographic blip has begun passing through the profession, with nearly a third of all registered practitioners between the ages of 25 and 35, which may reflect recent graduates from the country’s new dental schools. There are 15,020 dentists, 1,276 dental hygienists; 1,137 dental therapists; 1,195 prosthetists; and 784 oral health therapists. 

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NEWS & EVENTS

COVER STORY

YOUR BUSINESS

NEW PRODUCTS

YOUR LIFE

New products Caredent – Denture Brush Introducing Caredent’s NEW Denture Brush

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entures require daily brushing to ensure they remain fresh and stain free in order to maintain a healthy smile and long lasting dentures. Caredent’s new Denture Brush with its modern stylish design is a refreshing change from the standard brushes of the past. The thicker handle makes it easy to use, especially so for those with limited dexterity. Caredent Denture Brush has two strong and effective brush heads, one in the traditional toothbrush form and a smaller round head effective stain removal. The brush bristles are made

from Tynex®, a premium quality nylon manufactured by DuPont. Each bristle has optimum end-rounding reducing the likelihood of scratching the surface of the denture. In addition to the bristle heads the Caredent Denture Brush has the unique feature and benefit of a rubber polishing tip stain eraser to remove tough stains caused by tobacco, coffee, red wine and cola type drinks. Contact Caredent – Tel 02 9987 4891. Web – www.caredent.com.au 

iLight Suction 8

iLight Suction is a revolutionary Australian designed dental device that is improving dentistry for the whole dental team, including the patients! iLight Suction provides continuous and uninterrupted suction in the mouth, internal illumination via in built LED lighting and retraction of the mouth, whilst keeping the patient wide open and completely comfortable. iLight Sucton is an easy to use system that can be installed in any surgery in a matter of minutes. The device is easy to insert into the patients mouth and even easier to remove. The single use disposable mouthpiece prevents cross contamination and provides you and your patients the confidence of excellent standards in treatment. The effectiveness of the iLight Suction system is the flexible single use sterile mouthpiece that: isolates the maxillary and mandibular quadrants at the same time; provides bright white shadowless illumination via in-built LED lighting; retracts and protects the oral cavity; provides continuous full mouth

suction keeping the oral cavity fluid and debris free; keeps the mouth open via in-built bite block; and provides the patient maximum comfort due to its soft flexible material. You now will be able to perform dentistry without the hassle and disruption of tongue, cheeks, saliva, cotton rolls, lack of light, patient inability to open, frequent spitting, moisture contamination, and so on. The system improves operator ergonomics and comfort, allowing maximum vision of the operating field. Increasing the ability to see the operating field, will also improve posture, frustration and quality of your dentistry. You will also be able to perform your procedures faster, on average saving 30 per cent of your usual clinical time, and freeing up your dental assistant from suction allowing them to prepare and pass without interruption. The ultra bright long life LED light provides shadowless illumination and visibility in the oral cavity. The soft flexible mouthpiece adapts around the patients oral cavity. The mouthpiece contains a bite block to keep the mouth open and a body and end to retract the tongue and cheek. With so many benefits of the iLight Suction, it makes smart personal, professional and business sense to incorporate the iLight Suction as an essential operating tool. The iLight Suction can be used for a variety of treatments, these include: general dentistry, bonding, fillings, crown and bridge preparations, crown and bridge cementation, inlay and onlay preparation and cementation, digital impressions, cleaning and polishing, veneers, air abrasion, laser dentistry, dental implant surgery, dental implant prosthetics, paediatric dentistry, fissure sealants, and much more. It is available to order online at www.ilightsuctiojn.com.au, where you will also find videos and other useful resources. 


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NEWS & EVENTS

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YOUR WORLD

YOUR TOOLS

YOUR LIFE

Blurred lines How closely do you follow best practice guidelines? Dental Health Services Victoria is keen to find out. By Sue Nelson

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etter health outcomes and increased access to good dental services are at the heart of a new pilot study into the efficacy and accessibility of the clinical practice guidelines. Dental Health Services Victoria (DHSV) has initiated the study to assess the viability of determining how closely best practice guidelines are followed. Clinical guidelines are the most practical way to disseminate current best practice information to dentists and ensure quality and consistency in dentistry across the board. DHSV publishes clinical guidelines to help dentists provide consistent, high quality, evidence-based dental care in accordance with current literature. “If you’re looking at it from a patient’s perspective, you’d expect that whatever treatment your dentist is insisting you undertake is consistent with the best quality practice within that profession,” says DHSV epidemiologist Dr Richard Clark, who is leading the study. But how can that profession be confident of delivering quality outcomes, given the sheer volume of the dental literature and the need to stay informed?

“If an individual health practitioner wanted to be educated in the current research, to cover one year’s worth of interest in a specialist area or subspecialty, they’d probably need to read for two hours every day for 80 years,” says Dr Clark. “So it’s impossible for a single person to be up with all the latest research and then to translate that into implementing best practice. A practitioner cannot undertake this on his

Quote

these have translated directly into good practice. The study, which is in its pilot stage at the moment, aims to assess the current baseline adherence to the guidelines, and how any gaps might be addressed with a range of interventions. DHSV has engaged six dentists to review randomly selected patient records. The dentists have been trained in clinical audit techniques and will evaluate paper and electronic records to see whether

Dr Richard Clark, DHSV epidemiologist

“It’s impossible for a person to be up with all the latest research and then to translate that into implementing best practice.” or her own and maintain a practice at the same time.” This is where the guidelines come in for a wide range of professions, to provide assistance to health professionals and to implement best practice consistently across the field in which the guidelines apply. DHSV publishes a number of guidelines on its intranet—a closed external server accessible to the Victorian public dental system—but there is currently no way of knowing how

there are gaps between evidence-based best practice and actual practice. “The aim of the project is to develop a model that would facilitate undertaking clinical audits to check whether clinicians are adhering to guidelines,” says Professor Hanny Calache, director of clinical leadership education and research at DHSV. The guidelines are not only in place to ensure the best patient outcomes— including consistent quality and safety in service delivery—but also to


How closely can—and should—you follow clinical guidelines in all situations?

ensure the system runs efficiently. “We want to minimise the failure of, say, restoration of teeth, which then has to be done again,” Professor Calache says. “We need to be able to manage the disease rather than simply manage the symptoms. This would minimise the likelihood of patients coming back unnecessarily for additional visits, which has an impact on wait lists; which in turn has an impact on accessibility of the service for other patients.” There are also instances in dentistry

where patients may desire an outcome that the practitioner may not consider best practice—for example, where the use of white fillings may not be indicated, or may not be cost effective, in the dentist’s opinion. The guidelines can help to resolve an issue and, most importantly, ensure that the patient is providing informed consent. “Evidence-based care involves having a conversation with the patient about the service you’re going to provide,” says Dr Clark. “Some patients go along

with whatever is recommended, but a lot of people in the community are welleducated about health and it is important to involve them in that discussion, particularly where there are options. “This is where the clinical guidelines come into play, because they provide the evidence for the clinician to explain the consequences of various options—and for this to be recorded in the notes. It should be recorded that the discussion has taken place and the patient made an informed decision.”


YOUR WORLD

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There may also be instances where a practitioner decides not to follow a guideline because there are specific circumstances that weigh against it—in this instance, good record-keeping is essential. Part of the purpose of the pilot study is to investigate how records are kept. This is a way of assessing quality of care, but can also be used to deliver the guidelines to clinicians more effectively. “If you’re going to do a clinical audit you have to go back and read the narrative that has been written and pull out the information,” says Dr Clark. “We want to see if there’s a possibility that we can update our electronic system so that it won’t be so onerous to check, manually, every entry that every clinician has put in, using search terms.” The study will look at how the guidelines can be made more compatible with electronic health record search criteria, to allow practitioners to search an item number at the point of care delivery and call up a list of guidelines to consider that are specific to that procedure. “Studies have shown that clinicians need to know information within two or

three seconds; they don’t want to go away and read a book,” says Dr Clark. There are a number of factors that might be behind a dentist not adhering to the guidelines—if dentists are not aware of them in the first place, it may be necessary for DHSV to address the dissemination process. “We make the guidelines available online, but that’s as far as we go, so we need to develop an implementation process so that dentists are aware of the latest information,” Professor Calache says. “We’re not selecting dentists to audit—we’re randomly selecting health records, and using a group of dentists to review the records. This is not an exercise to catch out dentists who don’t follow guidelines; it’s an exercise to check whether clinicians, as a group, show practice consistent with the guidelines.” DHSV is also developing a process that encourages clinicians to read the guidelines online and answer a few questions—dentists can then be allocated some continuing professional development hours. “The aim of the research is to support

and, if necessary, improve professional development,” Professor Calache says. “Our purpose is also to assess our processes—how we’re actually making sure clinicians are aware of the latest evidence-based information that has come out.” Ultimately, it’s a question of communication—ensuring that dentists understand the value of following the guidelines. “We’re looking to involve other stakeholders, like the Australian Dental Association, and consulting with the wider professional community,” says Prof Calache. “Currently we’re focusing on the public sector within a couple of sites. The next step would be to expand the number of guidelines we’re looking at, and to expand the number of public sector agencies involved. Following on from that would be a relationship with the private sector. Ideally we want to look at agreed national guidelines (for example those published by National Health and Medical Research Council or the Therapeutic Guidelines Oral and Dental) so that people going from one state to another get uniform quality of service.” 

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NEWS & EVENTS

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No-handed dentistry

Is adopting a CAMBRA approach to treatment doing yourself out of business? By Andy Kollmorgen 14

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o self-respecting dentist would skimp on preventative treatment just to make sure patients have a reason to come back and spend more money. Well, at least not deliberately. But adopting a Caries Management by Risk Assessment (CAMBRA) approach, regarding as international best practice these days, inherently involves trying to reduce the need for invasive procedures. The goal is to prevent cavities, not fill them. Are Australian dentists who are embracing CAMBRA putting their economic lives at risk? The consensus among the seasoned practitioners we spoke to is no, but putting the onus of prevention on patients does mean changing the way you practise dentistry. The problem with CAMBRA from a business standpoint is that much of it takes place outside the dental surgery, where billable services are few and far between. The patient management and monitoring side of the philosophy includes a strong emphasis on oral hygiene, proper teeth brushing, plaque control and diet, especially the reduction of sugar. In short, the approach is a lot more holistic than most Australian patients are used to. But with the growing emphasis on holistic health in the medical profession as a whole, could Australian dental culture be changing with the times? It turns out the idea of a patient-led approach to prevention has been kicking around for a while. Five years ago the Australian Dental Journal published a study on the idea of applying a Caries Management System to Australian dentistry and laid out a nononsense case for its importance: “The challenge today is to develop a non-invasive model of practice that will sustain a low level of primary caries experience in the younger generation and reduce risk of caries experience in the older generations.” And some elements of CAMBRA have long been in play, mainly in the

form of fluoridated water and toothpaste. The concept is also alive in the halls of academia. The principles of CAMBRA are currently being put to the test through a six-year trial at the University of Sydney started in 2009 and funded by the National Health and Medical Research Council. The trial, which also uses the term Caries Management System, is tracking the progress of 920 patients under the guidance of Sydney University Associate Professor Wendell Evans, who reported a 31 per cent decline in the need for invasive treatments at the trial’s halfway point in July 2011. Achieving the positive results didn’t require extreme measures —trial subjects showed big improvements just from brushing their teeth twice daily with a fluoride toothpaste and receiving a fluoride application during regular dental visits. “Simple non-invasive practise can halt the decay process completely,” A/Prof Evans said. Participating dentists also got some hands-on help in how the system works. “We trained dentists in how to coach their patients on removal of the daily plaque build-up. We also guided them on how to apply professional-strength topical fluoride systematically on tooth surfaces to promote the restoration of lost mineral and tooth hardening, and how to monitor the outcome.” But could it really be the beginning of the end of the drill-andfill era? After all, preventative dental care has shallow roots in Australia. Calling the dentist when you have a problem, as opposed to making an appointment to prevent one, has long been the default option. Bite talked to a few seasoned pros who advertise themselves as preventative dentists and got some interesting responses. None of the practitioners we spoke to were practising CAMBRA in the strictly scientific sense, but they drew from its principles to come up with a system that works for their respective practices.


It’s good for your patients, but is it bad for business?


YOUR BUSINESS

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Dr Adel Zayed, a principal of the Monash Dental Group in the Melbourne suburb of Clayton who’s been practising for 27 years, told us that drilling the fundamentals of oral hygiene into patients’ heads is the best way to avoid having to drill into their teeth. Ideally, the lessons will be passed down. “A main focus for us is to educate young parents about good oral hygiene—basic things like brushing, flossing and, when appropriate, applying a topical fluoride treatment. The benefits of these simple steps can be quite profound. We’ve found that the quality of a patient’s oral health has a lot to do with the family environment.” Dr Zayed also offers everyday advice, such as choosing tap water over bottled water (since it’s fluoridated) and applying the right kind of tooth mousse. Is showing patients how to look after themselves chipping away at the bottom line? “It’s really the opposite,” Zayed says. “When you can get your patients into good prevention programs, the scope of dentistry that you practise might change. But there will still be lots of work. In general, there will be less caries and cavities, but other aspects of dentistry will flourish.” Dr Stephen Lising, a former chair of the ACT branch of the ADA and currently the owner of Preventive Dental Care in the ACT suburb of Deakin, says much the same thing. He’s been practising for 15 years, but the principles of prevention for this particular practice go back to the 1970s, when the first hygienists had to be imported from America due to a lack of local expertise. For CAMBRA candidates, a bit of tough love can go a long way. “We tell patients why they’re in a high-risk category, and then structure a home-maintenance protocol. It does take some effort to teach them. We use a camera to show patients’ what’s in their mouths so they can see for themselves.

Study Online

Associate Professor Wendell Evans, whose trial of CAMBRA principles at Westmead is showing very positive results.

Dr Lising also scoffs at the notion that teaching patients to take their oral health seriously might be a bad business move. In his view, practitioners who may not focus as much on prevention as they should, unconsciously or otherwise, are probably stuck in the past. “Some old-school dentists might have that attitude, but I’d say the majority of dentists don’t take that approach. The main thing our hygienists are trying to prevent is periodontal disease. And that means visits at least every six months. These days I’m mostly dealing with cracked teeth and caps. Seeing a lot less caries doesn’t mean the practice is less busy.” 

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The price of care 18

Working in the healthcare sector can be draining, particularly when it feels like you’re getting nowhere fast with patients looking for an instant fix. But the natural consequence, compassion fatigue, can lead to burnout if it’s not properly managed. By Amanda Lohan

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octor Jillian Benson is a medical GP working in some pretty challenging environments. Among other roles, she currently works with newly arrived refugees at the Migrant Health Service, and with remote Aboriginal communities through the Kakarrara Wilurrara Health Alliance. Benson has been part of the team organising a World Health Organization-sponsored mental health program for nurses working in Vanuatu, and is active in Doctors’ Health South Australia. It’s a tough job, but somebody has to do it, and Dr Benson has learned that self-care is a vital piece of the puzzle. “I work in some difficult areas so I obviously need to make sure I look after myself,” she says. “I also work in doctors’ health so I’m interested in helping other people look

after themselves.” Consequently, Dr Benson has undertaken considerable academic work in the areas of vicarious trauma, burnout and compassion fatigue, and has some useful tips for overcoming these hurdles. “To me, compassion fatigue is just a fancy definition for a really bad day,” says Dr Benson. While there is no universally agreed definition for compassion fatigue, Dr Benson says that you can recognise it as that feeling where you’ve simply “run out of being nice for the day”. The edge of anger that can be interpreted as a lack of respect for the patients can have a harmful impact on your therapeutic relationship. While anyone can experience compassion fatigue, it is more commonly found in people who lack support, who are isolated, or who have their own personal experience with neglect or trauma. It is also more common among those who work with a difficult clientele. For dentists,

the challenge might arise from being frequently faced with chronic disease, patients looking for a quick fix where none exists, or working with people who have suffered trauma or neglect. In this environment, it can be difficult to identify signs of progress towards wellness. Benson calls this “therapeutic impotence”. “You’re not seeing changes so you don’t feel like a good therapist. You take what’s happening with the patient and internalise it and make it your fault, which often turns into anger.” As a result, you may become irritable, drink too much, isolate yourself socially, retreat into computer games, or just generally stop looking after yourself. “Everybody will have unhealthy ways of coping,” says Dr Benson, “and we all secretly know what they are.” “The difficulty with compassion fatigue is that we might come home and be a bit grumpy and have a beer or scotch and watch some crap on TV and the next day


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we’re fine,” says Dr Benson, “but if we do that day after day it starts to become a habit.” At this point, Dr Benson says you begin to move into burnout territory, which is far more difficult to treat. Regular reflective practice will help you to identify when you start exhibiting the signs of compassion fatigue, but the next step is to act. Fortunately, there are many things that can be done to directly combat compassion fatigue. A healthy diet, regular exercise and adequate sleep will always be up there on the list of self-care recommendations, but Dr Benson says that the idea of what is “healthy” should extend to everything you do. There is considerable anecdotal evidence to support the pursuit of at least half an hour of endorphin-producing activity a day. It begins with spending more time doing the things you enjoy so that work stresses have a smaller role to play in your daily life. While the idea of pursuing hobbies may sound like a simplistic solution, Dr Benson says there is much to be gained from these “success experiences”. “If you have a difficult clientele, genuine success at work may be a rare thing. Hobbies allow us to fill that void,” she says. Talking to other people about your concerns may also help to lessen the burden. Peer support can be

obtained through a structured arrangement such as ongoing clinical supervision, or it can be found in less formal settings such as debriefing with family and friends or “talking shop” with colleagues at a CPD event. For those people without an adequate support network, or for whom the peer support mechanisms aren’t working, she advises seeking formal psychological help, “As health professionals it’s something we’re not good at, but it can be good for us, our friends and family, and particularly our patients.” For many, a sense of spirituality can also help to restore the balance. “It’s not necessarily religious,” she explains, “It’s just something that takes you to a deeper part of you. It’s about why we help people, our purpose in the world and our relationships with other people.” It may involve referring to a piece of literature that informs a way of behaving, such as a religious text or a poem, or it might be as simple and accessible as an inspirational fridge magnet that reminds you of why you wanted to become a health professional in the first place. Dr Benson says that addressing your own needs will have a direct positive impact on your patients as well, because it will help you provide better care. “We need to give out of our fullness, not our emptiness.” 

Further reading Read about the role of peer support in combating compassion fatigue in ‘Compassion Fatigue and Burnout – The Role of Balint Groups’ by Jillian Benson and Karen Magraith (Australian Family Physician, Royal Australian College of General Practitioners, 2005). You can also check out the chapter on self-care for health professionals in the book Mental Health across Cultures: A Practical Guide for Health Professionals by Jillian Benson and Jill Thistlethwaite (Radcliffe Publishing, Oxon, 2009). In addition, the NSW Health Education & Training Institute has produced the comprehensive ‘Oral Health Superguide’ covering best practices for supervisory relationships. It is a great, practical resource for supplementing organised peer support activities. Download a copy at www.heti.nsw.gov. au/programs/cssp/oral-healthsuperguide. 


INNOVATION:

IT’S WHAT WE DO.


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life imitating art

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t comes as little surprise when Dr Yvonne King admits one of the passions of her life has always been art. As someone who has spent almost two decades of her career working in aesthetic dentistry, her admission of the love of beauty of aesthetics explains a great deal about the career path she had not only followed, but had become an industry pioneer in. “My interest in aesthetic dentistry happened gradually, but I do believe it comes from the fact I always liked art,” Dr King admits in her practice, Cosmetic & Laser Dentistry Centre, in Caulfield, Melbourne. “I liked dissecting things that were aesthetically pleasing, and that then translated into dentistry. I would take pride in providing a tooth colour restoration that looked beautiful as well as being functional. I would take pride in doing anterior restorations and seeing

the joy on the patient’s face and hearing the feedback as to how it changed their life. From that, it built to where it became a passion.” Yvonne King’s passion has proven to be a powerful force in dentistry, and crossed many boundaries in her career. In the years she has focused on aesthetic dentistry, she recalls a time when it was dismissed as ‘cosmetic work’ or the pursuit of vanity, through to today where it has finally earned respect for its own place within the many fields of dentistry. It is with a sense of pride in her voice when Dr King talks about her efforts to bridge the gaps and work to bring credibility to aesthetic dentistry. In 2012, Yvonne King proudly became the first Australian dentist to earn a Masters degree in Aesthetic Dentistry (with distinction) from London’s King’s College. “Yes, I am thrilled and it is wonderful,” she says. “I am excited as I feel I have helped contribute to the

acknowledgement of aesthetic dentistry as a specialty and thus reinforcing its credibility. Previously, no matter how much education there was, there was no consideration of aesthetic dentistry being a speciality, in spite of many dentists being very knowledgeable and doing beautiful work. “To be an aesthetic dentist is now a specialty just like prosthodontist or an orthodontist,” she concludes. It was not that long ago that Dr King found a number of her Australia dental community colleagues either didn’t really understand the importance of aesthetic dentistry, or they had little respect for it. “We were just not considered credible, and you couldn’t advertise without being frowned upon,” she says. “Now the image of the profession is changing and aesthetic dentistry is a speciality. I believe there will be more people who will take it up as a speciality because all of us want to provide treatment that is good, strong and valid,

Photography: credit

It has been a long climb, but Dr Yvonne King has become a pioneer for the recognition of the important role of aesthetic dentistry in the medical marketplace. By John Burfitt


COVER STORY

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and not be the superficial treatment dealing purely with appearance that at times it was perceived to be.” In her three-year Masters course, Dr King worked in Australia with a number of case studies conducted in her own clinic as well as extended periods each year in London. Her research thesis explored the survival of composites in the treatment of an anterior pathological tooth wear. “We are seeing more people today who, due to lifestyle factors, are wearing their anterior teeth to a point where there is very little left of their teeth, so it’s first and foremost a functional issue, but it’s also an aesthetic issue,” she explains. “As a profession we are looking at materials we can restore the teeth with so we don’t have to cut the teeth further. Because these teeth are already destroyed, we really don’t want to cut away even the little bit that has been left behind. So we’re looking at composites as an alternative means of restoring these teeth and their long-term survival.” While she was the first to achieve the distinction of the higher studies in aesthetic dentistry, Dr King says she is not the only one. “I know there were at least three Australian dentists sitting the first-year exams when I was sitting the second year, so there would be a few following me,” she says. “And now King’s College has brought the course to Australia and

it’s being run in conjunction with Sydney University. So, times are changing, and that is a good thing for everyone.”

Y

vonne King hails from a highachieving medical family, with a father who has a PhD in virology and a mother with a PhD in physiology. The decision to go into dentistry was motivated, she claims, by the chance to combine her two passions of medicine and psychology. “I remember telling my dad I didn’t feel like studying medicine, but I wanted

Quote

This page, from left; Dr King at work in her Melbourne surgery; a glimpse of the interior: and before and after an aesthetic smile makeover.

Perth, Dr King moved to Melbourne just over 15 years ago where she met her husband Peter and together they set up a new practice, where she has been based ever since. “I remember in my initial studies in dental school, we were never taught anything about the psychological impact of dentistry,” she says. “It was later

Dr Yvonne King, Cosmetic and Laser Dentistry Centre

“I remember in my initial studies in dental school, we were never taught anything about the psychological impact of dentistry. It was later that the understanding began dawning on me—we’re dealing with so much more.” to be in an associated field, and I loved psychology,” she recalls. “So to me, dentistry was like the great marriage between medicine and psychology.” Dr King studied dentistry at the University of Western Australia in Perth, and later completed a diploma in clinical hypnosis. After almost a decade of working in

during that the understanding began dawning on me that it’s not just the teeth we’re dealing with—we’re dealing with so much more. Each set of teeth comes with a real person with a mixture of emotions attached to it and the way that person feels will determine whether they will go through a course of treatment. It’s up to us to educate and motivate them


25 and understand them in such a way as to allow them to walk the road to what is ultimately of great benefit to them. “I am talking about the whole treatment because really, the smile comes at the end. I am talking about empowering the patients to have a healthy functional mouth, to be in charge of it and how to maintain it. That is what I think we all need to work towards.”

I

t is when Dr King gets onto the topic of the human smile that her true passion really comes to the fore. On the website of her other clinic, the Melbourne Aesthetic Dental Centre, her mission statement is: “My goal is to fulfil every patient’s dream of a beautiful smile, whilst establishing and maintaining a healthy and functional oral environment.” It is an issue she insists on taking seriously, and as she explains her dedication, it highlights her commitment to dentistry as the true marriage of medicine and psychology. “There is the very negative spiral that people can enter into when they are unhappy about their smile,” she says. “When a person is not happy with or even ashamed of their smile, they don’t

feel motivated to look after their teeth. Therefore, almost inevitably, their teeth are going to deteriorate. “As the teeth deteriorate, these people tend to avoid social contact due to embarrassment. So their social life suffers, and their career may suffer because when people don’t tend to smile, they are viewed as lacking confidence or difficult to work with. “They may then slide into depression, and when people are depressed, they tend not to look after themselves, and that can go in many directions. So there are many, many facets to such a debilitating cycle.” Long before she earned her Masters, Dr King was already a pioneer in her field. She was the first dentist in Australia to utilise intra-oral cameras, in-surgery teeth whitening, and digital radiographs. She also pioneered in Australia the use of WaterLase and Hoya-ConBio DeLight hard and soft tissue lasers. In recent years, she has been honoured as a Life Member and Diplomat of the World Congress of Minimally Invasive Dentistry, and is also a member of the American Academy of Cosmetic Dentistry as well as a member of the Academy of Laser Dentistry.

In her clinic, Dr King says she spends most of her time with patients dealing with acute cases ranging from crowded, discoloured and broken teeth through to decay and gum disease. “Tooth wear is quite an issue these days and especially in the younger population,” she adds. “And there is a lot of it. “Periodontal disease is so prevalent and yet patients often say to me when I ask if they have ever had a periodontal chart done, ‘What’s that?’. Unfortunately they are often the ones who say that they have been going to the dentist every six months for years, however, they have never been educated or examined for presence of periodontal disease. “Periodontal disease is the first thing we need to stabilise prior to moving on and considering cosmetic improvement with a patient. Healthy periodontium is a foundation of a healthy mouth. “At the same time, as much as we would like to believe decay today has been eliminated due to fluoride, we are still seeing multiple patients with it. “Healthy periodontium and decay-free teeth are the two very basic things we need to establish prior to getting our patients to where they really want to be.” 


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Management myths exposed Like every industry, dentistry has its fair share of management myths. We spoke with successful dental management specialists to save you the pain of discovering these myths the difficult way. Here’s what they had to say. By Chris Sheedy MYTH NUMBER 1: Owning your own dental practice is glamorous and preferable. “This used to be the norm. As soon as you graduated people would ask when you would buy your own practice. Those were the days when dentists used to make money by default. There was no need for business tools or management skills. But these days competition in the marketplace, rules and regulations, legislation and increasing numbers of dental health practitioners all make it more challenging. Assistant dentists working in well-managed practices can make a very decent income and not have the responsibility of running the business. If you want to experience successful practice ownership you need to put in lots of hard work and be prepared to learn business skills.” Dr Toni Surace

MYTH NUMBER 2: Daily meetings should allow time for everything that every staff member wishes to discuss. “Meetings without clear agendas are a mistake. If there isn’t an agenda and

somebody to manage that agenda then don’t bother having the meeting. Daily meetings should always have a fixed agenda. The meeting should only last five to ten minutes—it’s like a pilot running through a check-list. Look at yesterday’s schedule and work out what went right and what went wrong. Discuss what you need to adjust and patients you need to call back etc, then look at today’s schedule and quickly discuss anything important. Anything that comes up that is more detailed should be introduced into the weekly meeting agenda, to be discussed in a longer meeting.” Anita Roubicek

MYTH NUMBER 3: Really good staff just aren’t available. “There is really no such thing as the perfect, ready made staff member that dentists would define as having an amazing personality, decades of experience and willing to work for sandwiches. The problem is many practices aren’t willing to pay for great staff. They don’t make time to train them properly and they don’t identify what the most important feature is

for the role they are trying to fill. To fit best into my business people need to have great interpersonal skills. I hire for personality and train the skill every time. I recruit from the hospitality industry where people have developed exceptional customer service skills, and I can then provide the specific knowledge they need to succeed. Don’t use the words ‘must have dental experience’ if you expect to get outstanding, long term staff.” Dr Myles Holt

MYTH NUMBER 4: Patients can’t afford costly procedures. “Dentistry in most cases is a luxury, particularly costly procedures. Convincing people to accept these procedures involves a deep understanding of a patient, their motivators and concerns towards their oral health and their specific dental issue. Some people truly cannot afford costly treatments but often a comment such as ‘I can’t afford it’ can mean other things such as ‘I don’t see the value’ or even ‘I don’t trust you’. Some of the most successful practices are in lower


socioeconomic areas. The dentists simply have great communication skills. So know how to build relationships and provide patients with what they want.” Dr Toni Surace

MYTH NUMBER 5: Before-andafter photographs in the reception room, hallways and restrooms etc generate patient desire for cosmetic treatment. “I believe it is a good idea not to waste the opportunity of having a captive audience and to use strong, interesting, humorous and unexpected visuals to convey a message regarding the services you offer and the patient benefit. The problem is often the types of visuals and their use-by date. Patients have seen before-and-after pictures of teeth and the same old smiling images so often they have lost their impact. Visuals should be changed regularly to keep things fresh “for returning clients.” Dr Myles Holt

MYTH NUMBER 6: The dentist can’t work any harder than they already do. “It is certainly true that there are only so many hours in the day, but there are also only so many patients available. Smart dentists realise the goal is to work more productively with each patient rather than simply being a mass patient conveyor belt. Forward thinking dentists now look for new ways to offer more to their existing patients, rather than looking for more patients. For example, the addition of

A hygiene department is essential for maximum productivity in the long run as they also enable the dentist to do more productive work

Botox and Dermal Fillers at a standard recall appointment takes only 5-10 minutes more than the exam/clean, yet fees increase by over $1000. This comes from existing patients, without the need for the expensive pursuit of new patients.” Dr Myles Holt

MYTH NUMBER 7: All members of the dental team should be aware of the need for selling dental products as they provide an important profit centre for most successful practices. “It all comes down to the motive for selling products. If the motive is purely financial gain, many patients will sense this a mile away. But if the dentist and their team truly believe in the products they are selling, that they truly benefit patients, this is a great service and will be sold with enthusiasm and received

Our Myth Busters 1) Anita Roubicek – Management Consultant and Partner of dental practice management company Prime Practice 2) Dr Myles Holt – multiple practice manager and Director of the Australian Academy of Dento-Facial Aesthetics (AADFA) 3) Dr Toni Surace – Managing Director of dental business consultancy Momentum Management


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MYTH NUMBER 9: The more you know about management the more success you’ll have. “Knowledge and action are two different things. You can do every course under the sun, read books and watch management videos but if you don’t use that knowledge to create real change you will never be as successful as you could be. Dentists know how things should be done and how to get better results but can also be their own worst enemies. They are often unable to implement what they have learned because it is easier to stay in their comfort zone. If this is the case they will never know what is possible. Knowledge is power but action is king.” Dr Toni Surace

MYTH NUMBER 10: Computerised record keeping will impress your patients. Convincing people to accept these procedures involves a deep understanding of a patient.

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“This is partly true. I think today’s patient does expect that things are computerised. If you don’t have up-todate systems it makes you look as if you’re behind the game. The problem arises when dentists interact more with the computer than the patient. The computer must not take the place of the relationship with the person. And if you look at the computer too much then the patient wonders if you even know what you’re doing. Use the computer as a tool to help communicate with the patient, as a visual tool. But don’t use it as a crutch. It must not be used to the detriment of the relationship.” Anita Roubicek

MYTH NUMBER 11: Cute/ funny recall cards demean the importance of dentistry. Hire for personality and train the skill every time.

with thanks. Patients appreciate the professional recommendation that allows them to cut through the hype and confusion that is the wall of products on the supermarket shelves.” Dr Myles Holt

MYTH NUMBER 8: For maximum productivity, hygienists should have per-day quotas of appointments. “To a certain extent I agree with this as it gives the hygienist something to strive for. A certain level of productivity

is important, but it is not everything. Good hygienists create happy patients, resulting in greater productivity for the practice as patients remain loyal, make referrals and agree to treatment options. A hygiene department is essential for maximum productivity in the long run as they also enable the dentist to do more productive work. The daily target of the hygiene department does not have to be met to gain an increase in productivity for the practice as a whole.” Dr Toni Surace

“If you’re in a very serious city practice where the dentist is referred to as ‘Doctor’ and your clientele are business people then it looks quite strange if you have a cartoon character on a cute, funny recall card. But if you’re a fun, friendly, family practice and the dentist has a personality that relates to the card they’re sending then it works. This is more about aligning the image of your brand with any correspondence you send, whether it’s a recall card or a letter. It’s not about making the industry seem serious or otherwise, just making sure all materials match your brand.” Anita Roubicek. 


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Implants product guide Bite magazine’s guide to the best implants products for dentists on the market today


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Implants product guide Ergonomic perfection! Now with Mini-LED+ Designed for oral and maxillofacial surgery and implantology, W&H’s new range of surgical straight and contra-angle handpieces offers unbeatable visibility and ergonomics for the oral surgeon.

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he new W&H surgical handpiece features yet another breakthrough in LED lighting with the introduction of the Mini LED+ which provides outstanding light in an incredibly small package just half the size of previous LED’s. A-dec W&H product manager, Shal Hafiz, said W&H invented the concept of using LEDs in dental handpieces and has been continually evolving the design, making it a clear leader in the field. “The new Mini LED is now inbuilt into the tip of the instrument, with the slimmer head design and LED+ lighting together offering superior visibility of the treatment site. The unique selfgenerating power supply means no special cabling is required. “Importantly, W&H’s patented LED+ daylight quality light provides natural reproduction of red tones in the oral cavity providing a realistic view of gum and soft tissue health,” Mr Hafiz said. New improved grip design The all-new surgical handpiece range features a new contoured grip with a special ‘cut-out’ design that prevents the finger slipping forward during a procedure, allowing more precise control of the instrument. Left or right handed For the first time, W&H has also introduced the choice of removable left and right-handed spray clips. This means cooling can be tailored to individual operators without affecting visibility. “In the past, the cooling tube could obstruct visibility in certain situations. Now the coolant tube can be simply moved to the other side of

The new W&H surgical handpieces feature a non-slip grip, left or right handed cooling spray & mini-LED+ light for superior visibility

the instrument when required such as working in the opposite quadrant,” Mr Hafiz explained. New 45° surgical contra angle Another innovation from W&H is the world’s first true 45° head contra-angle surgical handpiece, combining the advantages of straight and contraangle handpieces for the first time. The 45° angle allows considerably better access and much better visibility of the treatment site. This is particularly helpful in the surgical extraction of wisdom teeth,

precise tooth separations and apical resections. The surgical handpieces are made of durable and high-quality stainless steel with a scratch-resistant coating, can be fully dismantled for cleaning and maintenance, and are fully thermo-washer disinfectible and sterilisable. Contact A-dec on 1800 225 010 for a comprehensive brochure of the W&H oral surgery and implantology range, or visit: wh.com and search for Oral Surgery & Implantology. 


Everything under control

NEW The new surgical instruments The new design puts a whole range of advantages at your fingertips: fatigue-free working thanks to optimal ergonomics. Considerably better access to the treatment site thanks to a new neck geometry with removable spray clips which can be attached on either side. Ideal illumination thanks to the mini LED+ positioned near to the head. The scratch-resistant surface facilitates cleaning. Chairs Delivery Systems Lights Monitor Mounts Cabinets Handpieces Maintenance Sterilisation Imaging

For more information Email: a-dec@a-dec.com.au Phone: 1800 225 010 Visit: www.wh.com Follow us on Twitter: @A_decAust

Š 2013 A-dec Inc. All rights reserved.

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Implants product guide Integrated Facescanner Welcome to the practice of the future!

W

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ith the Facescanner integrated in GALILEOS x-ray units, the vision of the virtual patient is coming within reach: while taking the x-ray, this scanner plots a virtual face scan that is simultaneously superimposed with the 3D x-ray data. The face scan helps you to plan your therapy, makes treatment more comprehensible for your patients, and thus ensures greater understanding and trust. As part of the vision of virtual patients, orthodontic and maxillofacial surgery applications are also being planned. It is absolutely plausible that dentists will be able to simulate changes to the facial surface resulting from surgical or orthodontic procedures using morphing software before starting any procedures, thus being able to clearly show patients the possible results of a therapy. BENEFITS Patient marketing with the GALILEOS Facescanner • Patients identify themselves more easily with a face scan than with an x-ray image • This enables them to better understand therapy suggestions and to more readily accept them • Questions and misunderstandings can be more easily answered or clarified through Doctor/Patient codiagnosis • The perception of the dental practice improves thanks to word-of-mouth recommendations by patients • No additional scan time is necessary, patients do not need to be repositioned, and there is no tedious superimposition of the data thanks to simultaneous recording and automatic registration.

FacescanExport in Dolphin

TECHNICAL DATA An overview of the GALILEOS Facescanner: • Laser-free technology, gentle operation with white light • All GALILEOS devices can be retrofitted • Easy data exchange using software from other manufacturers, e.g., for orthodontic measurements • Integrated viewer software with easy operation • Data superimposed with high precision.

Above: The face scan is displayed in an integrated viewer. The CBCT image and the face scan are automatically superimposed.


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Contact your local Sirona representative for more information. Australia: 1300 747 662 www.sirona.com.au New Zealand: 0800 747 662 www.sirona.co.nz


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Implants product guide A Proven Heritage Inspiration behind innovation

C

onvinced that existing implant systems were too complex, Professor Neil Meredith and Fredrik Engman founded Neoss in 2000. Their idea was to rationalise both implant design and treatment to create a truly simple solution. The result is a high quality, optimised implant system featuring two implant designs – ProActive Straight Implant and ProActive Tapered Implant. PROVEN DESIGN AND SURFACE OF NEOSS IMPLANTS Material Our implants are produced in Commercially Pure Titanium Grade IV.

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Dual surface roughness ProActive Implants have a low surface roughness flange (Sa 0.4) designed to reduce marginal bone loss.1 At the same time, higher surface roughness of the threaded body of the implants (Sa 1.0) optimizes stability and osseointegration. Unique thread cutting and forming design The universal Thread Cutting and Forming (TCF) design of the implant ensures suitability for all bone qualities. The secondary cutting face provides additional efficiency in dense bone.2 Threads extend to the tip of the implant ensuring excellent stability. Proven clinical experience A randomly selected population of 100,000 implants was sampled from the Neoss warranty registry and statistical analysis indicated a 3 year cumulative survival rate of 98.2%. Of the 1.8% of failures the major aetiological factors were smoking, a combination of poor bone quality, bone quantity and immediate loading.3

Quote “A randomly selected population of 100,000 implants was sampled from the Neoss warranty registry and statistical analysis indicated a 3 year cumulative survival rate of 98.2%.”

FEATURES OF THE NEOSS PROACTIVE® SURFACE Super hydrophilicity • Surface roughness and hydrophilicity are essential to the absorption of proteins and biomolecules onto implant surfaces thereby facilitating healing and bone formation.4 • Neoss has utilised Electrowetting on titanium surfaces to increase hydrophilicity and maximise the penetration of blood and its components onto the implant surface. • The ProActive Implants have a super hydrophilic surface demonstrated by an immeasurable low contact angle.  1. Sennerby L, Persson LG, Berglundh T, Wennerberg A, Lindhe J. Implant stability during initiation and resolution of experimental periimplantitis: an experimental study in the dog. Clin Implant Dent Relat Res. 2005;7(3):136–40. 2. Meredith N; A review of implant design, geometry and placement. Appl Osseointgrated Res 2008 6 pp 6–12. 3. Neoss Product Performance Report 2009 1 pp20–26 (in press). 4. Davies J, 1996. ‘Dynamic Contact Angle Analysis and Protein Adsorption’ in Davies J (Ed), Surface Analytical Techniques for Probing Biomaterial Processes, CRC Press, New York.


NeoLoc® Implant Abutment Connection NeoLoc® is the unique Neoss implant to abutment connection that offers the advantages of a remarkably strong and tight connection, proven long-term clinical success, high levels of bone preservation and the ‘one connection’ concept.

A Strong Connection Mechanical integrity of all the components that make up a complete implant pillar is key to successful long-term tooth replacement. The clever design of the Neoss Implant System, including NeoLoc®, combines abutment deformation lugs, an unparalleled strong implant1 and a high performance abutment screw. Together these provide an outstanding implant pillar with a high clamping force that resists micromovement and long-term fatigue.2

Neoss Abutment Deformation Lugs Neoss engaging abutments have deformation lugs which minimise rotational movements and secures a distinct seating.

Crystaloc™ Abutment Screw Crystaloc™ abutment screws are 30% stronger than gold screws in static strength testing facilitating a high clamping force between the abutment and implant.3 The outcome is an additional 10% resistance to fracture during long-term clinical function.2

Neoss Implants Historical warranty data shows that Neoss implants have an unprecedented low fracture rate1 with less than 1 fractured implant per 100,000 implants used.

One Connection Intelligent Simplicity has long been the ethos of the Neoss Implant System. With the ‘one connection’ concept at its core, restoration is made easy and communication is simplified among the dental team. Neoss offers one connection for ProActive Straight and ProActive Tapered Implant diameters Ø3.5 mm to Ø5.5 mm:

ONE insertion tool ONE impression coping ONE prosthetic connection 1. 2. 3.

4.0mm

4.0mm

4.0mm

4.0mm

4.0mm

3.5mm

4.0mm

4.5mm

5.0mm

5.5mm

Neoss Warranty data on file Fatigue Performance according to ISO 14801, Neoss Sponsored Report van Staden R, Guan H, Loo Y, Johnson N & Meredith N, 2008. ‘Comparative Analysis of Two Implant-Crown Connection Systems - A Finite Element Study’ Applied Osseointegration Research, vol.6, pp.48-53

Neoss Australia Pty. Ltd · P.O. Box 404 · New Farm Q 4005 · T +61 7 3216 0165 · F +61 7 3216 0135 · E info.au@neoss.com

www.neoss.com


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Aesthetic options for restoring abutments

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n implant should be considered as a restorative procedure with a surgical component. Proper treatment planning will help achieve maximum aesthetics, functionality and biomechanical success. The global trend driven by patients towards metal-free dentistry has placed heightened responsibility on the dental team to provide excellent natural-looking restorations. This requires open communication between the dentist and skilled, educated laboratory personnel augmented with as much information as can be supplied both by parties. The decision to opt for either a cement-retained or a screw-retained prosthesis is based on many factors. With the increased popularity in customised abutments, the use of preformed off-the-shelf abutments is becoming more infrequent. The use of customized abutments allows for more individualised placement of crown margins in relation to the gingival tissues. The angulation of alveolar bone will determine the tooth position relative to the occlusal plane. The bone width can limit the angle of implant placement. When implants are non-aligned, angled abutments allow for parallelism. The use of

angled abutments can economize on treatment time, cost and the need for complex periodontal interventional procedures. Superior aesthetic results can be achieved with non-aligned implants with cement-retained crowns. In the highly crucial anterior area, zirconia abutments combined with a lithium disilicate (e.max) crown in an occlusally neutral environment provide a beautiful, durable restoration. More posteriorly, where more strength is required, zirconia

restorations are involved. When strength and aesthetics are required with a screw-retained crown, a titanium interface with a zirconia abutment veneered with ceramic is an excellent choice. When economics also becomes a consideration in case management, a titanium interface used in conjunction with a combined monolithic zirconia abutment and crown is a useful option. As the population ages, dental requirements change. Older dentitions with cosmetic and

Quote The use of customized abutments allows for more individualised placement of crown margins in relation to the gingival tissues. abutments can be placed under either fully milled zirconia or porcelain fused to zirconia (PFZ) crowns. A zirconia abutment under a laminated zirconia (PFZ) crown will ensure an aesthetically harmonious and sturdy restoration. Retrievability is an important consideration when screw-retained

functional requirements requiring a “green dentistry approachâ€? seek softer dental materials which aim to minimize occlusal wear. This can now be achieved with zirconia abutments and resin nano-ceramic materials (such as Lava Ultimate). Careful planning of cases by both dentist and technical support teams ensures a suitable restoration for the myriad of clinical situations that present on a daily basis. Streamlined delivery of restorative dentistry is enhanced by communication between all members of the dental team. The provision of dentistry occurs in a complex bio-dynamic environment. The input from highly skilled technical support enables the clinician to provide restorations confidently knowing that both current and future needs of the patient are taken into consideration.ď‚Ł


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VOUCHER ID #DISC38 (RRP $246)


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Implants product guide Dealing with Everyday Complications As with any other profession, the practice of dentistry occasionally presents unusual challenges that call for professional counsel and collaboration. Words of wisdom, tips and advice, are available from colleagues, of course, but also here in our continuing Q&A column.

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ew surgeons have had more experience with implants than Dr. Bertil Friberg. He studied with Professors Ulf Lekholm and Per-Ingvar Brånemark and has been a fixture at the Brånemark Clinic in Gothenburg, Sweden, since its inception. A respected educator as well as an experienced clinician, Dr. Friberg shares some of his insights concerning implant-based treatment in the following Questions and Answers.

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In a situation of limited jawbone volume distal to the canine tooth in the maxilla — that is, sparse volume for two implants due to an anteriorlyextended maxillary sinus — which implant site should I prepare first? Dr. Bertil Friberg: It would probably be a good idea to prepare the most distal implant site first (the one in the second bicuspid region). Preferably, this work should be carried out parallel to the anterior wall of the sinus, heading towards the canine, thus allowing for an implant of good length. Allowing the longer implant to be placed with mesial inclination in this area — where the jaw bone most

Dr. Bertil Friberg of the Brånemark Clinic in Gothenburg, Sweden.

3a

3c

Figures 3a and 3b show a situation in which the clinical team plans to replace the lower right canine and both lower right bicuspids with implants.

3b

3d

3e

Figures 3c, 3d and 3e. The 8-year-old implant seen to the left will be replaced with three new ones. Dr. Friberg considers the trephine drill to be the instrument of choice for removal procedures such as the one illustrated here. It is available in a variety of diameters from Nobel Biocare. These images represent only the first steps in a series of restoration procedures that will ultimately result in three new implant-anchored teeth.

often has less volume and density and the chewing forces tend to be higher — makes sense from a loadbearing and longevity point of view. In this configuration, the mesial site (in the first bicuspid region) provides less height, but enough room to accommodate a short implant. Placing the short implant in the distal site, where there is less bone volume and lower density — as well as the aforementioned higher chewing forces — constitutes a less appropriate solution and a rather less certain longterm prognosis. If I were to run into excessive bone loss around one or several implants related to infection, what would you advise? Friberg: A program of conscientious hygiene control, sometimes subsequently including explorative surgery with bone plasty, may be the solution to the problem. However, before

beginning such a course of treatment, you should be aware that a successful outcome is in no way ensured. The case to the above illustrates an alternative plan of action. Here the clinical team plans to replace the lower right canine and both lower right bicuspids with implants (figures 3a and 3b). Instead of producing a threeunit prosthetic construction supported by two new implants and the old one, which has been adversely affected by bone resorption, the l-year-old implant (figure 3c) will instead be replaced with three new ones. The tool of choice for such a removal procedure is a trephine drill (figure 3d), available in various diameters from Nobel Biocare. The final image (figure 3e) shows the surrounding bone after removal, which presents a fresh site for continued treatment.  This article is a reprint from Nobel Biocare News Vol. 15, No.1, 2013.


NOV 2013

7th

8th

VIC

11th

WA

NSW

12th QLD

Dr Bertil Friberg & Dr Torsten Jemt Exclusive Australian Event This exclusive event brings together Dr Bertil Friberg and Dr Torsten Jemt from Sweden, two pioneers of oral implants, to share their clinical and scientific insights on key aspects of oral implantology. This is a lecture event not to be missed with two highly renowned international speakers sharing their knowledge from a unique long-term perspective gained from their 30 year experience with over 40,000 oral implants.

Dr Bertil Friberg

Clinical implications and current research Dr Friberg’s presentation will focus on suggested causes for marginal bone maintainence, discussing the influence of patient characteristics such as oral and general health, oral anatomy, patient habits, as well as the influence of factors including surgical techniques, and the choice of micro and macro designs used. Clinical cases will be presented to illustrate the lecture content. Topics covered in this lecture include: • • • • • •

Expected implant outcome of single-tooth, partial and total edentulism Clinical cases Complications Grafting procedures Implants and systemic diseases Conceivable causes to marginal bone loss

Dr Bertil Friberg received the DDS degree in 1975 from the University of Gothenburg. He Joined the Brånemark Clinic in Gothenburg in 1986, where he is currently an Associate Professor and Co-Chairman of the clinic. Through the University of Gothenburg he received his master degree in dental science in 1994 and a doctorate in odontology in 1999, and he is a board certified specialist in Oral and Maxillofacial Surgery. He was appointed as Visiting Professor at Siena University in 2004. He has given more than 1000 national and international presentations and he has published over 50 scientific papers.

Dr Torsten Jemt

Clinical considerations in treatment planning what can we learn from long-term follow-up studies Dr Jemt’s presentation will cover 25 years of long-term data on patients provided with early single implant techniques. Biological response to the foreign body implant, deep placement of implants in situations without bone grafting, and single crowns with “ridge-lapping” techniques will be discussed. Furthermore, adult facial growth and risk assessments for single implant infraposition due to changes of occlusion in the adult patient will be covered.

Professor Torsten Jemt received a DDS degree in 1975 in Gothenburg, Sweden, and was Board Certified as a specialist in Prosthodontics in 1982, and received a PhD in 1984. Dr Jemt was a co-worker with Professor P-I Brånemark in the development of the single implant abutments, and CAD/CAM titanium frameworks. He became Associate Professor in 1986 and later served as Professor in the Department of Prosthetic Dentistry and Dental Materials at the Sahlgrenska Academy at Gothenburg University. He co-founded the Brånemark Clinic in Gothenburg where he has served as Chairman between 2000 and 2009. Now he holds a combined scientific position at the Faculty of Odontology and at the Public Dental Health Service. Dr Jemt is a member of the Editorial Boards of the International Journal of Prosthodontics, and Clinical Implant Dentistry and Related Research. He has published over 130 articles and lectures worldwide.

Register today! live text

AOS VIC: AOS WA: AOS QLD: NSW:

Maggie McBain • 0403 358 019 • infoVIC@aos.org.au Australasian Dr Roy Sarmidi • (08) 9404 9500 • rsarmidi@yahoo.com Osseointegration Society limited Dr Robert Junner • (07) 3839 4586 • junner@me.com Nobel Biocare Australia • 1800 804 597 • educationanz@nobelbiocare.com

OS

paths


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Implants product guide Tapered Plus BioHorizons’ newest titanium implant system offers increased soft-tissue volume and maximum attachment.

B

uilding on the popular features of the Tapered Internal implant system, the Tapered Plus implant system maximizes both bone and soft-tissue attachment (with its Laser-Lok-treatment bevelled collar) and soft tissue volume (via platform switching).

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The versatility of platform switching More than 2 decades ago, when widediameter implants and platforms were first introduced, compatible prosthetic components were not immediately available. Many of these 5.0-mm and 6.0-mm implants consequently received readily available smallerdiameter abutments and prosthetic components. A happy accident, it was found that vertical change in crestal bone height was much less with these restored “platform-switched” wide-diameter implants than with conventionally restored implants. Platform switching is now common in implant dentistry, and BioHorizons Tapered Plus implant system lends itself to this technique. Tapered Plus implants feature a bevelled collar and are packaged mount-free for quick placement and maximum visibility. The protocol increases softtissue volume around the implant connection, a major contribution to long-term implant aesthetics.

Locked and lasered The portion just below the implant connection and above the threading of all Tapered Plus implants incorporates BioHorizons proprietary Laser-Lok microchannels, an exclusive surface treatment that promotes physical connective-tissue sealing and maintains crestal bone for natural-looking restorations. A series of precision-engineered, cellsized circumferential channels are laser-machined onto the surface to significantly improve bone and tissue maintenance over time (study citations are available). Abutments feature the Laser-Lok microchanneled surface as well. Feature-rich components The threaded portion of Tapered Plus implants features a buttress-thread configuration that enhances primary stability and maximises compressive bone loading. Buttress threads have a wide, flat leading edge for increased functional surface area and improved axial load distribution. Tapered Plus implants are offered in 4 body diameters: 3.0 mm (not available with platform switching), 3.8 mm, 4.6 mm, and 5.8 mm. Five lengths are available, depending on which body diameter is selected. The complete Surgical Kit contains

a wide range of Tapered Plus components supplied in a reducedheight tray with a built-in drill measurement guide and maximum ventilation for fast drying. The surgical Kit has an intuitive, colour-coded layout that guides clinicians through the instrument sequence, which begins in the upper-left, works left to right, and then down. All components, including the surgical tray, are available individually, as well. A full line of ancillary drills, wrenches, drivers, burs, and cutters, as well as abutments and healing caps, round out the Tapered Plus line. Science and innovation Founded in 1994 as an “incubator company” at the University of Alabama at Birmingham, BioHorizons was born out of research by a team that included renowned dental implant pioneer Dr. Carl Misch. The company’s current CEO Steve Boggan is a biological and biomedical engineer. BioHorizons sold its first implants in 1997 and has been continually developing, improving, and acquiring innovative implant systems and complementary products ever since. Tapered Plus is BioHorizons’ latest brand and builds upon proven technologies and expands them with innovation. 


make the

switch The Tapered Plus implant system offers all the great benefits of BioHorizons highly successful Tapered Internal system PLUS it features a Laser-Lok treated beveled-collar for bone and soft tissue attachment and platform switching designed for increased soft tissue volume.

platform switching Designed to increase soft tissue volume around the implant connection

Laser-Lok速 zone Creates a connective tissue seal and maintains crestal bone

prosthetic indexing optimized threadform Buttress thread for primary stability and maximum bone compression

For more information, contact BioHorizons Customer Care: 1300 13 12 19 or shop online at www.biohorizons.com SPMP12245 REV B OCT 2012

Conical connection with internal hex; color-coded for easy identification


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Implants product guide

S

electing a power brush to recommend involves an understanding of toothbrush technology, the results that can be achieved and the needs of patients. The Triumph 5000 power brush from Oral-B is claimed to offer efficacy, flexibility and multiple options to meet the needs of patients.

Daily Clean mode are used for implantsupported crowns and bridges, followed by the Power Tip brush head which is guided ‘interproximally’ between the (abutment) teeth and pontics The FlossAction brush head and the Daily Clean mode are recommended for studs, stud attachments, and bars. For studs and stud attachments, rotating the brush around the studs, and using gentle pressure with the

Features of the Oral-B Triumph 5000 include: Wireless Smart Guide to encourage adequate brushing time and compliance. Five modes: • ‘Daily Clean’ mode (default) with 48,000 pulsations and 8,800 oscillations per minute, and a 2-minute timer • ‘Deep Clean’ mode measuring 45 seconds per quadrant (in total 3 minutes) •‘Sensitive’ mode with reduced speed and no pulsations •‘Polish’ mode • ‘Massage’ mode with gingival stimulation Triple pressure control sensor alerts patients if excess pressure is being applied, using a red light on the handle, stuttering and stopping pulsations Multiple interchangeable brush heads to address different clinical situations Battery Level Indicator

• •

42 The Oral-B Triumph 5000 is an oscillating-rotating power brush with a pulsating feature generating over 48,000 movements per minute. The oscillating-rotating technology has been extensively researched with more than 250 clinical and scientific studies, proving its efficacy in plaque removal and gingivitis reduction. Oral Hygiene and Implant Maintenance For implant patients, thorough home care is essential to prevent the onset of peri-mucositis and subsequent periimplantitis. If prostheses are present, oral hygiene is further complicated by the difficulty of accessing all areas necessary for adequate oral hygiene. With these facts in mind, the availability of multiple interchangeable brush heads for the Oral-B Triumph 5000 helps patients achieve plaque removal around implants, studs and attachments, bars, hybrid and fixed implant-retained dentures, and around single-unit and multi-unit implantsupported crowns and bridges. The Precision Clean brush head and

IMAGES COURTESY OF DR. JOSEPH MASSAD

Advancing Oral Hygiene for the Implant Patient

• • •

brush head in a vertical position so that the bristles enter the stud (or attachment) optimizes cleaning. For bars, the brush head is used under the bar and around all surfaces. The Power Tip brush head can also be used in a sideways manner under the bar. The FlossAction brush head and Daily Clean mode are also used under fixed hybrid prostheses, as well as on the surfaces of prostheses, followed by the Power Tip brush head to reach under the prosthesis and to clean along its length. In summary, the Oral-B Triumph 5000 with interchangeable brush heads has been designed to ensure that there is a suitable brush head design for patients, including implant patients, irrespective of the type of prosthetic restoration. The Oral-B Triumph 5000 offers an effective, safe and userfriendly option with proven oscillatingrotating technology, to improve home care and oral health. 

Quotes “Oscillating-rotating powered toothbrushes remove plaque and reduce gingivitis more than manual tooth brushes in the short and long term. No other powered designs were consistently superior to manual toothbrushes” “Brushes with oscillating-rotating action reduced plaque and gingivitis more than those with side-to-side in the short term (412 weeks)’ - Cochrane Collaboration systematic review (2011)


You’ll never look at toothpaste the same way again…

Gingivitis

Plaque

Sensitivity Caries

Enamel Erosion Halitosis

Calculus

Staining

ORAL-B PRO-HEALTH® One toothpaste with the benefits of many. Our first and only toothpaste with a breakthrough formulation of stabilised stannous fluoride and sodium hexametaphosphate. This combination amplifies its plaque reduction, sensitivity, and acid erosion benefits. 15 years of research and over 100 clinical and scientific studies have helped validate this latest innovation.

TALK TO YOUR TERRITORY MANAGER ABOUT EXPERIENCING BETTER DENTAL PROTECTION WITH ORAL-B PRO-HEALTH OR PHONE 1800 282 265 FOR MORE INFORMATION


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Implants product guide iChiropro – A touch of Swiss genius, Bien-Air Dental S.A

T 44

he Swiss company BienAir is revolutionising the dental industry. It has launched a pioneering world first onto the market: iChiropro enables practitioners to control their implantology and surgery system using an iPad. This revolutionary system paves the way for a new generation of medical devices. It enables practitioners to improve levels of comfort, efficiency and also safety. Each procedure is automatically linked with the patient’s file which is integrated into the iPad control interface. iChiropro documents all of the operations performed, thereby ensuring constant and extremely rigorous monitoring of practitioners’ activity. Moreover, iChiropro enables multiple users to save their own settings. Finally, it is pre-programmed with the complete operating sequences from the largest implant manufacturers and their new functions can be added at any time by updating the application which is free of charge from the Apple App Store. iChiropro is equipped with the technological innovations for which Bien-Air has become renowned: theMX-i LED micromotor with lifetime-lubricated and maintenancefree ceramic ball bearings, and the CA 20:1 L Micro-Series internal irrigation contra-angle, fitted with one of the smallest heads ever designed and a double LED system for uniform lighting. The iChiropro is available in Australia from Anthos Australia Pty Ltd and William Green Pty Ltd. 

Quote “iChiropro enables practitioners to control their implantology and surgery system using an iPad.”

www.williamgreen.com.au www.anthos.com.au


ICHIROPRO NEW VERSION OF THE APP ICHIROPRO VERSION V1.2.0

IMPLANT BARCODE SCANNER ENSURE IDENTIFICATION AND TRACEABILITY OF AN IMPLANT WITH A SIMPLE SCAN With just one scan, the reference, batch number and expiry date contained in the implant’s barcodes are added to the operation report instantly. This ensures the data is accurate, the implant is traceable, and saves you time. This function is available for the following implant brands: Nobel Biocare, Straumann, Thommen Medical, Camlog, Bredent, Euroteknika, Bti, BioHorizons, MIS and Neoss Compatible iPad 3 et 4. Visit itunes.apple.com to download the iChiropro application for free To see Implant scan demo go to www.youtube.com and search iChiropro

NEW PRE-PROGRAMMED OPERATING SEQUENCES TO FACILITATE YOUR OPERATIONS iChiropro integrates the complete operating sequences for the main implant manufacturers. To make your operations even simpler, the sequences for the following brands have been added:

• BioHorizons • MIS • Neoss • Dio

The operating sequences for the implant manufacturers Straumann, Camlog, Euroteknika and Dentsply Implants have been completed and updated.

CONTINUOUSLY EVOLVING FOR EVER BETTER PERFORMANCE To improve the performance offered by your system, new, innovative functionalities are being regularly added. In addition to the implant barcode scanner and the new pre-programmed operating sequences, the V1.2.0 version of the iChiropro application offers the following new features:

• Maximum torque reached indicator (only with Bien-Air’s CA 20:1 contra-angle) • Overview of the operation report option to view the operation report in PDF format before sending by e-mail • Dental numbering system option to display using the FDI system (ISO-3950) or Universal system (US) • New patient file design


You Asked We Delivered

TMJ made simple & Common Sense CASE FINISHING

Dr Steve Galella DDS, IBO

International Lecturer, Inventor & expert on human facial growth & development

As it applies to all straight wire systems

Just some of the things you will learn TMJ Treatment

Classification of orofacial pain. Intracapsular disorders. Temporomandibular joint anatomy, physiology, & function. Diseases of the TMJ. Nutrition, patient cooperation. Splints construction and adjustments.

Common Sense Case Finishing

How to Develop Rock Solid Successful Treatment Plans. Developing the perfect treatment design, the beginning of case finishing. Dealing with the unexpected, making changes on the fly. The difference between cookbook orthodontics & innovative logical thought. Why bad things happen to great treatment plans. Learn How To Problem Solve.

“You will learn a personalized 7-step process that guarantees your cases will finish every time regardless of which Straightwire technique you’re using”

Amora Hotel SYDNEY Saturday; Sunday; Monday. 2 - 4 November 2013

Places strictly limited!

Registration: call 1300 ORDERZ (1300 673 379) www.naol.com.au


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Tools of the trade A pharyngometer, phosphor plates, and a really sharp knife. It’s shaping up to be an interesting month...

No. 12 scalpel blade by Dr Jodie Dobson, Dobson Dental, Ferntree Gully, VIC I was at a seminar about 10 years ago and the speaker flippantly mentioned a particular way he used a No. 12 blade. I didn’t get much else from the seminar but that one little thing stuck with me. I used it in my practice the next day and was sold. For the past decade, that one throw-away line has influenced how I perform dentistry. What’s good about it I do a lot of aesthetic and restoration work with composite resins. Every now and then there’s a tiny little interproximal area that you need to trim. You might be flossing between the teeth and a minute overhang will cause a catch. I just pop my No. 12 blade in there and get rid of the tiny catch or overhang. It’s so quick, easy and efficient—it’s fantastic. It simply can’t be beaten for very fine adjusting of composite resin in a spot that’s too tight for a Soflex disc or a sanding strip. When using resins for anterior aesthetic work, often a local isn’t required and interproximal strips can be quite painful on the patient’s gums. I just use the No. 12 blade to trim those difficult spots. It’s really straight forward and works beautifully. It’s not something that I use every day but when I need it—and I might only use it for half a second—it’s a real time saver. What’s not so good Originally, the blade had to be set up on a metal handle. It would take the nurse longer to prepare it than it took me to use it. That problem was fixed recently with the production of a disposable instrument with a plastic handle.

number of other diagnostic processes, in the preparation of mandibular advancement devices. These are designed to pull the mandible forward and reduce the amount of snoring or turbulence in the throat and nose of people with sleep apnea. I use this machine for a quick diagnosis but the most complete information comes from a polysomnogram—an overnight sleep test in a hospital to determine how many times a patient stops breathing in a night. What’s good about it The pharyngometer gives an indication of the patient’s airway space and simulates what happens at various stages of sleep. The patient bites onto the mouthpiece and breathes out all their air to allow the tissues to relax and collapse. As they are breathing out, it sends soundwaves down their airway and they reflect back. A visual representation is displayed on the screen, giving me an idea of how much collapse there is in the airway. I can then find a position by moving their jaw forward which will tell me whether an oral appliance is going to give a greater airway space. Patients are very comfortable with the pharyngometer. They are just biting on the mouthpiece so there is no gagging.

by Dr Ken Russell, Riken Dental Group, Adelaide, SA

What’s not so good It works fine but you need to keep in mind it’s not 100 per cent accurate. I always use the results in conjunction with other testing. It also needs a decent Windows upgrade. I’ve been using this pharyngometer for about seven years and it’s still working on DOS.

At the moment I’m doing quite a bit of dental sleep medicine. This pharyngometer is used, along with a

Where did you get it Body Logic. 

Where did you get it Dentavision. 

Eccovision pharyngometer

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(continued from page 47)

VistaScan by Dr Minyen Chia, North Lakes Dental Centre, North Lakes, QLD

48

In the past, I’ve used conventional film, digital sensor plate with cord and digital phosphor plate X-ray units. My choice is phosphor plates used in conjunction with VistaScan. What’s good about it The phosphor plate is very thin and looks just like traditional X-ray film. These plates fit into a paper holder or conventional plastic Rinn film holder. The film is easy to position and very pliable so there is no discomfort for the patient, even if they have a shallow palate. I also like that it is a cordless system so the patient can completely bite down for better bitewing assessment. Once the exposed plate is fed into the VistaScan unit, it’s scanned and the image will appear on the computer screen. The results only take 10 seconds to process and the quality of image is superior to conventional film. The software has a range of options that allows you to change contrast or density to get the best result. The image appears as a full-screen display and that’s very helpful when explaining to patients what’s happening with their teeth. I’m very happy with this unit. What’s not so good This isn’t crucial but the phosphor plates have a limited life. They last for about 2000 exposures and then need replacing. It’s a pretty long lifespan but it’s an ongoing cost and the plates aren’t cheap. We use Sidexis software and all the X-rays can be arranged by date but there needs to be some more flexibility in the system. However, there is other software that complements VistaScan, so you just need to find the one that suits you. Where did you get it Sirona. 

X-Smart Duo by Dr Peter Haddad, Kensington Dental, St Morris, SA Before purchasing this rotary endodontic system in 2010, I did a few courses and investigated a number of different models that were on the market. I really wanted something that was relatively simple and user friendly. What’s good about it I like the X-Smart because it is easy to get out of the drawer and set up. It has a finger control on the motor which switches the handpiece on and off. A lot of other systems use a foot control with a cable that can get in the way. This unit is designed to work with the Protaper file system. However, the torque and speed can be modified so that other file systems can be used. If the file starts to bind in the canal, the machine goes into automatic reverse and starts beeping to warn you. When using hand files, I always had consistent difficulty with the mesial canals of lower molars and buccal canals of upper molars. They are usually finer canals and instrumenting them to the desired length was always tricky. This rotary system is able to do the job better, easier and quicker. What’s not so good I’ve had some unusual responses with the apex locator. There’s a number of variables you need to watch in order to ensure an accurate reading. I am well aware of this but there are times when the readings are a bit confusing. Even when I get a reading that appears to be spot on, I still double check it with an X-ray. Where did you get it Dentsply. 


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On the run

50

This year I entered the inaugural Big Red Run, a charity event that raises money and awareness to fight Type 1 diabetes. The run starts in Birdsville and takes place in the Simpson Desert, well away from any four-wheel-drive tracks. For the first three days, you run 42 kilometres each day—the equivalent of a marathon a day. The fourth day is a little easier with a run of 31 kilometres. The fifth you run 85 kilometres—two marathons back to back. The sixth day is a doddle of eight kilometres. “I’ve always liked running but became interested in ultra-marathons when we walked the Kokoda Track in 2008. My wife Sharon, myself and another guy were the first three clients of a company running an express trip. Most people walk the Kokoda Track in six to 10 days. The company predicted that we would do it in five days. We did it in three. “That trip inspired us to enter the Gold Coast Kokoda Challenge on our return. It’s a 96-kilometre race for teams of four and we competed in 2009, 2010 and 2011. We also entered the 100-kilometre Oxfam Trailwalker in 2011 that took place four weeks after the Kokoda Challenge. In 2012 we entered the North Face 100 in Sydney which meant we completed three 100-kilometre races in eight weeks. This year we backed up for Oxfam, North Face and added the 250-kilometre Big Red Run. “Most of these events raise money for charities and we have some very generous sponsors. Invisalign donated $1000 in 2011, 2012 and 2013, and this year, 3M also donated $1000 for the Big Red Run. There are a few strange things about an ultra-event. The first is that the people who do really well tend to be older. Secondly, women can perform at exactly the same level as men. It’s one of the few sports where there is a completely level playing field. Ultimately it’s just about keeping on going. The opposition is the terrain, not the other people. “When you run in these events, there’s no phones, no internet, no anything. It’s just you stripped down to the bare bones and put to the extremes. It becomes a journey of self discovery and you really learn a lot about yourself. The Big Red Run was such an amazing experience, I’ll be back again next year. 

INTERVIEW: KERRYN RAMSEY

Dr Tony Weir of Tony Weir Orthodontics, Greenslopes, QLD, went on a six-day run through the Simpson Desert—by choice!


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Equipment and fit-out finance | Goodwill funding | Credit cards | Home loans | Commercial and property finance | Car finance | SMSF lending and deposits Transactional banking and overdrafts | Savings and deposits | Foreign exchange | Comprehensive insurance services Investec Bank (Australia) Limited ABN 55 071 292 594, AFSL 234975, Australian Credit Licence No. 234975 (Investec Bank). All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. Information contained in this document is general in nature and does not take into account your personal financial or investment needs or circumstances. We reserve the right to cease offering these products at any time without notice. You should review relevant disclosure documents and obtain independent financial and legal advice, as appropriate.


Clinically proven non-stop 12 hour protection against bacteria... Stannous fluoride toothpaste 12 hours after toothbrushing – significant bacteria regrowth

COLGATE TOTAL

Colgate Total provides

72

12 hours after toothbrushing – reduced bacteria regrowth

%

REDUCTION IN PLAQUE BACTERIA REGROWTH

12 hours after toothbrushing vs stannous fluoride toothpaste1*

*

*Dramatisation illustrating reduction of plaque bacteria 12 hours after toothbrushing with Colgate Total vs stannous fluoride toothpaste.

...and protects against most common dental problems, including: Tartar

Whitens Cavities

Fresh Breath Reduces 98% Plaque

12hr Antibacterial Protection Fights Gingivitis

For a healthy mouth recommend Colgate Total. * Tested against Crest PRO-HEALTH North American 1100ppm fluoride formula. Oral B PRO-HEALTH includes 1450ppm fluoride.

1 Furgang et al, J Dent Res. 2011; 90 (Spec Issue): Abstract 3073.

www.colgateprofessional.com.au | www.colgateprofessional.co.nz


Bite Oct 2013